Patients' perceptions of care and safety within psychiatric settings.

There is growing concern over institutional measures of control (e.g., seclusion, restraint) and other potentially harmful or traumatic experiences within psychiatric hospitals. The purpose of the present study was to examine the relationship between demographic variables, potentially harmful and/or traumatic psychiatric experiences, and patients' perceptions of care and safety in psychiatric settings among 142 public-sector psychiatric patients. Data revealed 45.1% of patients reported they had been to a psychiatric facility they would never want to return to, and the majority of patients did not communicate with staff after a distressing event occurred. There were no significant differences in perceptions of care and safety by race, gender, or age. However, patients who reported potentially harmful or traumatic psychiatric events were significantly more likely to report that they had been to a psychiatric facility they would not want to return to. Encouragingly, most patients (84.5%) reported that psychiatric facilities have become safer in recent years. These data suggest the need to better understand how adverse psychiatric events influence how patients view their care and their subsequent engagement in that care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anthroposophic perspectives in primary care

Anthroposophically Extended Medicine (AEM) is a truly integrative healing system. AEM represents an expansion, not an alternative to conventional medicine. Its unique understanding of the interplay among physiological, soul and spiritual processes in healing and illness serves to bridge allopathy with naturopathy, homeopathy, functional/nutritional medicine and other healing systems.     

Screening for skin cancer in primary care settings

OBJECTIVE: To estimate the frequency of recorded screening for skin cancer in primary care settings. DESIGN: Retrospective observational cohort study. SETTING: Two academically affiliated Department of Veterans Affairs Medical Centers. SUBJECTS: Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics. MAIN OUTCOME MEASURE: Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period. METHODS: Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits. RESULTS: Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination. CONCLUSION: Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.     

Patients' opinions of the role of primary care physicians and the organization of health care services

Patients' opinions of the role of the primary care physician were studied. The study population consisted of Hebrew-speaking members of the Clalit Sick Fund, aged 18+, who visited primary care and specialty clinics. Interviews took place during January-March 1995 in the Emek and Jerusalem, and during August-October 1995 in Beer Sheba. A total of 2,734 interviews were conducted, and the response rate was 88%. 64% of the respondents preferred the primary care physician as the first address for most problems occurring during the day. Multivariate analysis revealed that the variables predicting this reference were: being over age 45, having completed less than 12 years of schooling, being satisfied with the physician, and when a child's illness was involved. Whether the physician was a specialist had only a marginal effect. The findings also show that among those who did go directly to a specialist for the current visit, 49% would still prefer the primary care physician to be the first address for most problems. However, half of the respondents initiated the current visit to the specialty clinic themselves. The findings also showed that a preference for the primary care physician to be the first address had an independent and statistically significant effect on the following aspects of service consumption: taking the initiative to go to a specialist, the intention to return to the primary care physician or to the specialist for continuing care, and the patient's belief that referral to a specialist was needed. The findings of the study may be of assistance to policy-makers on the national level and to sick funds in planning the role of the primary care physician, so that it corresponds, on the one hand, to the needs of the sick funds and the economic constraints in the health system, and on the other, to the preferences of the patient.     

Contamination of diagnostic ophthalmic solutions in primary eye care settings

Pharmaceutical agents and irrigating solutions are widely used in both optometric and ophthalmologic practices. Contamination of these containers or solutions could possibly pose some risk of infection to a patient. We set out to investigate the possible contamination of a representative sample of these containers in small office practices. Representative bottles of two diagnostic pharmaceutical agents and an irrigating solution were obtained from primary care optometric and ophthalmologic practices in the San Francisco-Oakland Bay area. These bottles were tested to investigate the rate of contamination and to identify the types of microorganisms in the contaminated solutions. Sixty total samples (proparacaine, tropicamide, and an irrigating solution) were randomly cultured, and 11.7% of the samples showed contamination. Pseudomonas cepacia, Staphylococcus epidermidis, Pseudomonas putida, and Streptococcus species were the predominant organisms isolated from the contaminated bottles. In addition, 17 of the original 60 containers were further cultured for investigation of the dried residue particles around the threads of the containers. Of these 17 containers, 13 (76.5%) tested positive for Staphylococcus and Micrococcus species.     

Screening older adults for depression in primary care settings.

Primary care is a logical environment for depression recognition in older adults. Most older adults are diagnosed and treated for depression by primary care providers. Recognition systems for depression in this setting are particularly needed because the prevalence of depression in older primary care patients may range from 7% to 36%, depending on the instrument and diagnostic criteria used. Implementing systematic detection systems in primary care settings has proven difficult. In one study, only one third of all physicians surveyed used any formal screening tool. Though a number of barriers to recognition of depression have been identified, the authors focus their discussion in this article on two, time and patient factors, and review two screening instruments, the Geriatric Depression Scale--Short Form and the Center for Epidemiologic Studies Depression Scale, that may be able to address these factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive specificity in emotional distress.

Cognitive approaches to emotional distress posit that specific cognitive factors are critically linked to the etiology, course, or treatment of dysfunction. Although a number of empirical studies have assessed cognitive factors in emotional disorders such as depression and anxiety, research has yet to assess these variables simultaneously and with identical cognitive measures. Using depression and test anxiety as models of dysfunctional affective states, we examined cognitive specificity on measures of information processing, attributions, automatic thinking, and cognitive interference. Results indicated a pattern of specificity showing several differences and similarities in depression and anxiety. Specifically, "purely" depressed individuals showed evidence of selectivity processing depressive information, making dysfunctional attributions, and engaging in more negative automatic thinking. "Purely" anxious individuals, on the other hand, showed evidence of selective anxious information processing and increased cognitive interference. Results are discussed in terms of a taxonomy for classifying depressive and anxious cognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical interview skills and identification of emotional disorders in primary care

BACKGROUND: This study focuses on the detection of medically compromised dental patients in the Netherlands by means of a validated patient-administered medical risk-related history (MRRH). Due to social changes and scientific innovations in the past decade, more medically compromised patients will be needing special dental treatment. METHODS: The medical problems of 29,424 dental patients (age 18 years and over) from 50 dental practices in the Netherlands were registered by means of the MRRH. The patients were classified according to the ASA risk-score system, which was modified for dental treatment. An inventory of the number and nature of medical problems and the modified ASA risk score was drawn up in relation to dental treatment and age. RESULTS: The average age of the patients was 37.1 +/- 13.5 years. According to the current guidelines, dental treatment must be modified if the patient has an ASA score of III or IV. A relatively high percentage of patients ages 65-74 (23.9%) and 75 or over (34.9%) did have an ASA score of III or IV. Furthermore, the medical problems were classified into 10 categories, and the relationship to age was examined. The conditions that increased with age were hypertension and cardiovascular, neurological, endocrinological, infectious, and blood diseases. CONCLUSIONS: For the dental practice, these results mean that the MRRH can play an important role in adapting dental treatment to the specific needs of patients. This is especially important in the case of elderly patients.     

Psychological practice in primary care settings: Practical tips for clinicians.

Many psychologists are finding new opportunities for practice in primary care settings. These settings challenge many aspects of traditional practice and require adaptation and innovation. Psychologists must consider changes in their site of practice, treatment duration, type of intervention, and role as part of a health care team. This article describes the culture of primary care medicine and offers 10 practical tips for the adaptation in psychological practice to primary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic bronchitis: primary care management

Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over three months' duration during two consecutive years and the presence of airflow obstruction. Pulmonary function testing aids in the diagnosis of chronic bronchitis by documenting the extent of reversibility of airflow obstruction. A better understanding of the role of inflammatory mediators in chronic bronchitis has led to greater emphasis on management of airway inflammation and relief of bronchospasm. Inhaled ipratropium bromide and sympathomimetic agents are the current mainstays of management. While theophylline has long been an important therapy, its use is limited by a narrow therapeutic range and interaction with other agents. Oral steroid therapy should be reserved for use in patients with demonstrated improvement in airflow not achievable with inhaled agents. Antibiotics play a role in acute exacerbations but have been shown to lead to only modest airflow improvement. Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration and nutritional support also play key roles in long-term management of chronic bronchitis.     

Impact of a dietary change on emotional distress.

Investigated the impact of a dietary change on the emotional state of 3 21–50 yr old females and an 18-yr-old male, using a single-S design. Ss were selected on the basis of scores on a behavioral index of metabolic imbalance and a subsequent interview. The dietary change for 3 Ss consisted of a high protein, low carbohydrate diet void of sucrose and caffeine, whereas only caffeine and sucrose were eliminated for the 4th S. The dependent variable used with the 1st S was a self-report of symptoms experienced, whereas the Minnesota Multiphasic Personality Inventory (MMPI) and the Profile of Mood State (POMS) were used with the other Ss. Ss reported many symptoms and/or presented a distressed profile during baseline assessment. However, following a 2-wk dietary change symptoms declined, and the MMPI or POMS profiles reflected a more stable and less distressed individual. Results suggest that a dietary change can remediate the emotional distress exhibited by some individuals, with the type of change affecting the emotional response. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking screening and management in primary care practices

This study examined how pain coping efficacy and pain coping strategies were related to reports of pain during mammography. Subjects were 125 women over the age of 50 undergoing screening mammograms. Prior to their mammogram, all subjects completed the Coping Strategies Questionnaire (CSQ) to assess how they cope with day-to-day pain experiences. Ratings of pain during the mammogram were collected using a 6-point pain/discomfort scale, a 100-mm Visual Analog Scale, the adjective checklist of the McGill Pain Questionnaire, and the Brief Pain Inventory. Up to 93% of the women reported the mammogram examination was painful. On average, women rated the mammography pain in the low to moderate range. Considerable variability in pain ratings was found, however, with some women reporting severe pain and others reporting little or no pain. Correlational analyses were conducted to examine how coping efficacy (CSQ ratings of ability to decrease pain and ability to control pain) and coping strategies (CSQ pain coping strategy subscales) related to variations in pain report. There was a pattern for ratings of ability to decrease pain to be related to lower ratings of current mammography pain. Women who rated their ability to decrease pain as high reported lower average levels of mammography pain, lower ratings on the mammography pain/discomfort scale, and were much more likely to report having had lower levels of pain during their last mammogram. These findings suggest that women who rate their coping efficacy in decreasing day-to-day pain as low may be at higher risk for having a painful mammogram. Individual pain coping strategies were not generally correlated with pain ratings. Behavioral interventions (e.g., patient controlled breast compression) and cognitive therapy interventions (e.g., training in the use of calming self-statements or distraction techniques) designed to increase coping efficacy potentially could be useful in reducing pain in women who are at risk for pain during mammography.     

Irrational beliefs and the arousal of emotional distress.

Evaluated the extent to which endorsement of irrational beliefs as measured by the Irrational Beliefs Test (IBT) was associated with subjective, physiological, and cognitive indices (e.g., Trait scale of the State–Trait Anxiety Inventory and Fear of Negative Evaluation Questionnaire scores) of emotional distress in response to a stressful event delivered in a controlled experiment. 62 undergraduates served as Ss. Beliefs relevant to the stressor were more associated with negative cognitions than was either a belief less relevant to the stressor or general irrational thinking. However, a measure of the fear of negative evaluation was more frequently associated with measures of distress than were irrational beliefs. The equivalent and perhaps greater predictive utility of a more parsimonious, less inferential individual difference variable was interpreted as challenging the construct validity of the IBT and perhaps questioning the necessity of postulating the existence of irrational beliefs in accounts of the arousal of emotional distress. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in ethnically diverse women: Implications for treatment in primary care settings.

What do health care practitioners need to know about providing adequate care for depressed minority women? This article examined the prevalence of depressive symptoms and clinical depression in ethnic minorities, the extent to which current health service utilization is congruent with needs, and the effectiveness of treatments provided to ethnic minorities in the primary care setting. The impact of ethnic minority women's sociocultural context on symptom expression and help-seeking behavior is also discussed. Finally, the clinical implications for accurate assessment and treatment of ethnic minority women by both medical and mental health practitioners working in the primary care sector are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing the direct contact model to increase referrals for psychological services in primary care settings.

Generating a robust referral base from primary care clinics is an increasingly important and challenging task for professional psychologists. This article presents the direct contact model, an innovative system for generating this base without relying solely on traditional physician-initiated referral mechanisms. The direct contact model functions by (a) allowing patients direct access to services using the PRIMECARE Questionnaire and (b) having psychology staff take a proactive stance to initiate treatment. The utility of this model is explored, and suggestions for implementing the model in other settings are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of distress to mood disturbance in primary care and psychiatric populations.

Disagreement remains as how to interpret elevated scores on measures of self-reported distress. This study compared elevated scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) in 2 samples to mood disturbance as assessed in an interview. In a primary medical care sample, most distressed patients did not have a mood disturbance, and distress without mood disturbance was associated with little impairment. Primary care patients with elevated scores on the CES-D were less distressed and less likely to have mood disturbance, major depression, or impairment than distressed psychiatric patients. Few patients with mood disturbance in either sample failed to meet criteria for major depression. Implications are discussed for research on depression using self-report measures, for generalizations across clinical and nonclinical populations, and for screening for preventive interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)